title: Artificial dermis (Matriderm®) followed by skin graft as an option in dermatofibrosarcoma protuberans with complete circumferential and peripheral deep margin assessment.
abstract: Dermatofibrosarcoma protuberans (DFSP) is a locally invasive neoplasia with a pattern of infiltrative growth that leads to extended resections. To avoid unnecessary resections and spare tissues, its treatment requires an adequate assessment of the margins. We present a case where artificial dermis (Matriderm®) was used followed by skin graft for reconstruction. We present a 50-year-old woman with a DFSP in the occipital region. She was referred to us after a first surgery with positive margins. A wide local excision with a 2-cm margin was performed and periosteal tissue was also removed, which led to exposure of the skull. Matriderm was placed on the bone surface and dressings were changed every other day. Meanwhile, margins were evaluated by the complete circumferential and peripheral deep margin assessment (CCPDMA) and were positive for DFSP in the superior margin. After 4 weeks the area was completely covered by granulation tissue and a new resection followed by reconstruction with a skin graft was performed. With regard to the difficulties in the margin assessment in DFSP, we present artificial dermis (Matriderm) as an option for reconstructive surgery in these patients, especially when a skin graft cannot be performed as a first option.
authors.affiliation: Skin Cancer Department, Hospital AC Camargo, São Paulo, Brazil.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Bertolli
authors.affiliation: Skin Cancer Department, Hospital AC Camargo, São Paulo, Brazil.
authors.forename: Mariane
authors.initials: M
authors.lastname: Campagnari
authors.affiliation: Skin Cancer Department, Hospital AC Camargo, São Paulo, Brazil.
authors.forename: André S
authors.initials: AS
authors.lastname: Molina
authors.affiliation: Pathology Department, Hospital AC Camargo, São Paulo, Brazil.
authors.forename: Mariana P
authors.initials: MP
authors.lastname: Macedo
authors.affiliation: Pathology Department, Hospital AC Camargo, São Paulo, Brazil.
authors.forename: Clovis A L
authors.initials: CA
authors.lastname: Pinto
authors.affiliation: Pathology Department, Hospital AC Camargo, São Paulo, Brazil.
authors.forename: Isabela W
authors.initials: IW
authors.lastname: Cunha
authors.affiliation: Skin Cancer Department, Hospital AC Camargo, São Paulo, Brazil.
authors.forename: João P
authors.initials: JP
authors.lastname: Duprat Neto
mesh_terms: D003094:Collagen; D018223:Dermatofibrosarcoma / Q000473:pathology / Q000601:surgery*; D004549:Elastin; D005260:Female; D006258:Head and Neck Neoplasms / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D012535:Scalp; D012878:Skin Neoplasms / Q000473:pathology / Q000601:surgery*; D016038:Skin Transplantation; D017768:Skin, Artificial
chemical_list: C532298:matriderm; D003094:Collagen; D004549:Elastin
keywords: Artificial dermis; CCPDMA; Dermatofibrosarcoma protuberans